SB 905 West Virginia Senate · 2025 Regular Session

Requiring PEIA and other health insurance providers to provide payment parity for certain services

This bill requires the Public Employees Insurance Agency and other health insurance providers to ensure equal payment rates for behavioral health and mental health services compared to medical and surgical services. It mandates that insurance plans cannot discriminate between these types of care when determining coverage or reimbursement, aiming to eliminate financial barriers to mental health treatment. The legislation includes specific definitions for serious mental illness and establishes mandatory reporting requirements to track compliance. Additionally, the bill authorizes rulemaking to implement these parity standards and sets an effective date for the new requirements.

Issues: ✓ Healthcare

Bill status in committee 1 of 4 stages cleared

Introduction

Mar 2025

Committee Review

Floor Vote

Governor

Introduced Mar 24, 2025 Last action Mar 25, 2025

Maddy AI version diff · 1 comparison

What changed between versions

Introduced Version → Committee Substitute · 30 edits

MAJOR

The bill was amended from an introduced version to a committee substitute version, primarily adding comprehensive mental health parity requirements across multiple insurance articles and expanding coverage for behavioral health services. The committee version significantly strengthens the original bill by adding detailed provisions for autism spectrum disorder coverage, expanding mental health parity requirements to include substance use disorders, and adding new requirements for reporting and compliance monitoring.

Scope change

The bill's scope expanded from primarily affecting the Public Employees Insurance Agency to covering all health insurance carriers and plans in West Virginia, including group accident and sickness insurance, hospital service corporations, medical service corporations, dental service corporations, health service corporations, and health maintenance organizations.

SCOPE

Expanded applicability from only the Public Employees Insurance Agency to all health insurance carriers and plans in West Virginia

REQUIREMENT

Added comprehensive autism spectrum disorder coverage requirements for individuals ages 18 months to 18 years with specific diagnostic and treatment plan requirements

Added explicit requirements for mental health reimbursement parity with medical-surgical benefits for licensed mental health practitioners

Added detailed reporting requirements for nonquantitative treatment limitations and comparative analyses of medical necessity criteria

Added requirements for coverage of amino acid-based formula for severe protein-allergic conditions and impaired absorption disorders

Added requirements for coverage of children's immunization services through age 16 with specific exemptions from deductibles and copayments

Added requirements for coverage of 12-month refill for contraceptive drugs

Added requirements for general anesthesia coverage for dental procedures under specific circumstances

Added requirements for coverage of post-delivery care for mothers and newborn children in home care plans

Added requirements for coverage of annual prostate cancer checkups for men age 50 and over

Added requirements for coverage of annual kidney disease screening using specific testing combinations

Added requirements for coverage of general anesthesia for dental procedures for children age 7 and younger or developmentally disabled individuals

Added requirements for coverage of amino acid-based formula for treatment of severe protein-allergic conditions

Added requirements for coverage of children's immunization services from birth through age 16 with specific exemptions

Added requirements for 12-month refill coverage for contraceptive drugs

Added requirements for group life and accidental death insurance coverage of $10,000 per employee

Added requirements for optional group life and accidental death insurance coverage for employees, spouses, and dependents

Added requirements for separately rating different employee categories for claims experience purposes

Added requirements for maintaining medical and prescription drug coverage for Medicare-eligible retirees

Added requirements for authorizing treatment with nonparticipating providers when services are not available within established standards

Added requirements for concurrent review of behavioral health claims to continue coverage until determination is made

Added requirements for denial notices to include specific language about parity protections and appeals processes

Added requirements for annual reporting to Joint Committee on Government and Finance with specific data elements

Added requirements for updating annual plan documents to reflect comprehensive parity compliance

Added requirements for Insurance Commissioner to adopt legislative rules for compliance with parity provisions

Added requirements for Insurance Commissioner to conduct financial examinations and report results to Legislature

Added requirements for Insurance Commissioner to impose fines for noncompliance with parity provisions

DEFINITION

Added explicit definition of 'behavioral health, mental health, and substance use disorder' to include conditions from multiple diagnostic manuals including autism spectrum disorder

TIMELINE

Changed effective date from unspecified to July 1, 2026 for changes made in the 2025 Regular Session

ENFORCEMENT

Added enforcement provisions allowing the Insurance Commissioner to conduct financial examinations and impose fines for noncompliance

Floor votes

How they voted

No floor votes recorded yet.

Full legislative history

Actions timeline

Total actions

Key actions

Committee

Mar 25, 2025

Committee

To Finance

upper

Mar 25, 2025

Upper · Passed

Committee substitute reported, but first to Finance

upper

Mar 24, 2025

Committee

To Health and Human Resources

upper

Mar 24, 2025

Introduced

Introduced in Senate

upper

Mar 24, 2025

Committee

To Health and Human Resources then Finance

upper

1 primary · 0 co-sponsors